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General NPI Number Information
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NPI Number | 1588489462
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Entity Type | Organization
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Legal Business Name | FREDERICK LOPEZ PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 1012 E COOLEY DR STE B2
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City | COLTON
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State | CA
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Zip | 92324-3959
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Country | US
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Telephone | 909-251-2449
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Fax | 909-494-4208
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Provider Business Mailing Address
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Address Line | 27162 GOLDEN FIELD CT
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4538
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Country | US
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Telephone | 909-251-2449
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FREDERICK LOPEZ
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Credential | PSYCHOLOGIST
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Telephone | 909-251-2449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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